Korean Journal of Nephrology 2011;30(3):310-314.
A Case of Biopsy-Proven Acute Tubular Necrosis Associated with Vancomycin Overdose
Young Kwang Shim, M.D.1, Jung Eun Kim, M.D.1, Myeong Ho Yeon, M.D.1, Jae Hyun Choi, M.D.1, Mi Kyung Kim1, Mun Hyuk Sung1, Sun Moon Kim, M.D.1, Soon Kil Kwon, M.D.1, Hye-Young Kim, M.D.1 and Ho Chang Lee, M.D.2
Departments of Internal Medicine1 and Pathology2
Chungbuk National University College of Medicine, Cheongju, Korea
증례 : 과용량 반코마이신이 투여된 환자에서 신생검으로 확진한 급성 세뇨관 괴사 1예
심영광1, 김정은1, 연명호1, 최재현1, 김미경1, 성문혁1, 김선문1, 권순길1, 김혜영1, 이호창2
충북대학교 의과대학 내과학교실1 , 병리학교실2
Vancomycin has been associated with acute kidney injury, particularly in the concomitant treatment with aminoglycoside or in the presence of other risk factor such as preexisting renal disease, sepsis, or hemodynamic instability. Vancomycin-related nephrotoxicity typically manifests as acute tubulointerstitial nephritis. Biopsy-proven acute tubular necrosis associated with vancomycin intoxication in the absence of aminoglycoside has been reported only in very few cases. We report a case of biopsy-proven acute tubular necrosis associated with vancomycin intoxication that was treated by continuous venovenous hemodiafiltration. A 28-year-old male without preexisting renal disease received a massive overdose of vancomycin. The plasma vancomycin level was 440.3 μg/mL. Renal biopsy revealed acute tubular necrosis that there is marked thinning of the tubular epithelium with dilatation of the tubular lumens and severe foamy epithelial cell changes in tubules. Continuous venovenous hemodiafiltration resulted in efficient reduction of serum vancomycin levels, which was followed clinically by recovered of renal function.
Key Words: Vancomycin, Acute kidney tubular necrosis, Hemodiafiltration

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